Human factors were the underlying causes of contamination and foodborne illness according to a review of incidents over a decade in China.

Key benchmarks included unhygienic food practices, human negligence, regulatory violations and intentional and criminal activities - suggesting China has a weak regulatory regime for food safety, according to the authors, who cite past research which found inadequate inspection and insufficient surveillance systems.

The researchers suggested promoting hygienic practices, strengthening regulations and enhancing risk communication as a general strategy for food safety in the country.

Study sample and key findings

Xue and Zhang found a total of 99,487 illnesses for 2,387 incidents and 380 deaths in 183 incidents (about 7.7% of total incidents involved death).

Unhygienic practice led to 56.6% of incidents, 64% of illnesses and 124 (32.6%) of deaths.

The aim was to understand the risks of foodborne illnesses and deaths relating to food pathogens, food location and settings, implicated food vehicles, sources of contamination and human causes.

Microorganism was responsible for 57.8% of the incidents and 68.1% of the illnesses, but it was linked to 36.6% of the deaths.

Microorganism link

C. botulinum was the deadliest bacteria, although it caused only 1.3% of the incidents and 0.3% of the illnesses, it was responsible for 11.6% of the deaths.

Although specific microorganisms were not listed in the table, the researchers identified Vibrio Parahemolyticus, Salmonella, Proteusbacillus vulgaris, Bacillus cereus, Staphylococcus, Escherichia coli, Shigella, Clostridium botulinum, Vibrio alginolyticus and Aeromonas as being linked to 53.3% of the incidents, 64.6% of the illnesses and 16% of the deaths.

The team analysed 2,314 papers from 183 journals in a timeframe from 1999-2010 with 2,387 incidents of foodborne illness investigated.

Man-made chemical source

Man-made chemicals were involved with less number of incidents and illnesses, but they were linked to more deaths, causing 25.8% of the incidents and 15% of the illnesses and were responsible for 53.4% of the deaths.

The team found pesticides were responsible for 7% of the incidents, 4.3% of the illnesses, but 18.4% of the deaths.

Animal-based food, such as seafood, poultry, pork and beef, accounted for 48.9% of the incidents, 52.2% of the illnesses and 97 (25.5%) deaths but for 328 cases the food vehicle was unidentified.

Plant-based food, ranging from vegetables, rice, noodles and tofu, led to 25.1% of the incidents, 20.5% of the illnesses but 143 (37.6%) deaths.

Other food, including soup, mushroom, desserts and sauces, made up 12.3% of the incidents, 11.3% of the illnesses and 114 (30%) deaths.

The review cited under reporting, timely and thorough investigations not being possible in remote areas and not all results being published in professional journals as some of the limitations.

But they added that unified regulatory responsibility under the “Chinese Food and Drug Administration” and revised food safety law, third-party food inspection and food safety surveillance systems becoming available could lead to under reporting may become less of a problem and a follow-up study could then be conducted with more accurate data.